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ECOS IV Final > Osteopathic Approach to Obstetric Patient > Flashcards

Osteopathic Approach to Obstetric Patient Flashcards

1
Q

How does treating maternal somatic dysfunction impact the patient?

A
  • enhances homeostasis
  • facilitates adaptation to structural and hormonal chagnes
  • alleviates discomfort
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2
Q

How does pregnancy effect pre existing msk conditions?

A
  • Scoliosis:
    • may develop more pain
    • curves dont increase
    • possible inc. pre birth
  • RA
    • improved sx
  • Ankylosing spondylitis
    • aggravated by pregnancy
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3
Q

What msk chagnes occur during pregnancy?

A
  • anterior tilt of pelvics with exaggerated lordosis of low back
  • flexion of upper back and lower neck
  • anterior internal shoulder roattion
  • ligamentoyus laxity
  • weakness/separation of abdomen muscles
  • increased mobility of SI joinnts and pubic symphysis
  • compression of sutures due to fluid retention
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4
Q
A

decreased ROM of lumbar spine

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5
Q

What low back pain symptoms are red flags and need further evaluation/referral?

A
  • Severe pain interferring with function and non positional persistent pain at night
  • increased pain with cough sneezing
  • neuro sx:
    • bladder bowl incontinence, loss of strength, weakness, sensory deficits, abnormal reflexes
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6
Q

Who is at risk for LBP in pregnancy?

A
  • Previous hx
  • multiparity
  • high BMI
  • smoking
  • age
  • strenuous work
  • dysmenorrhea

80-95% resolves after birth

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7
Q

Hemodynamic chagnes in pregnancy?

A
  • inc. in cardiac output, blood volume, plasma volume
  • decrease in systemic vascular resistance, blood pressure, hematocrit
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8
Q

How should pregnant women lay?

A

Left lateral recumbent position as laying on the right can compress the IVC leading to dec CO, SVR, and increased HR

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9
Q

the picture shows snake like blue/purple engorged veins on the vulva.

A

recommend she sleep in the left lateral recumbent position

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10
Q
A

stagnant hypoxi

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11
Q

What is relaxin?

A
  • elevated during first trimester declines in second
  • remains stable throughout pregnancy
  • responsible for weidening and mobility of SI joints and pubic symphysis around 10-12 weeks
  • women with LBP have higher levels of relaxin
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12
Q

How does progesterone impact pregnant women?

A
  • Promotes fluid retention
    • dec. oxygen and metabolism at cellular level
    • inc metabolic waste products in soft tissues and GI tract
  • changes thoracic cage configuration
    • increases circumference
    • subcostal angle widens
    • diaphragm pushed superiorly
    • increases tidal volume
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13
Q

Indications for OMT in ob patient?

A
  • SD
  • scoliosis or structural condition with pregnancy
  • edema or congestion
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14
Q

Relative contraindications to OMM in OB patient?

A
  • PROM
  • premature labor
    • contractions of uterus resulting in changes in cervix before 37 weeks
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15
Q

absolute contraindications?

A
  • placental abruption
  • placental previa
  • prolapsed umbilical cord
  • undiagnosed vaginal bleeding
  • ectopic pregnancy
  • thereatened or incomplete abortion
  • severe pre-eclampsi/eclampsia
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16
Q

Goals of treatment in pregnant patient?

A
  • address postural stressors
  • treat SD allowing body to compensate for changes from pregnacny better
17
Q

In the first trimester what should you look for in a PE?

A
  • mechanical issues
  • postural exam 3 planes
  • thoracic cage and inflet fascia
  • pelvis and sacrum
  • CRI
18
Q

With Hyperemesis gravidarum where should you treat?

A
  • OA-C2 and T5-9
19
Q

During second trimester how often are visits?

A

Monthly

20
Q

What do you expect to find on a pregnant woman during second trimester in terms of SD?

A
  • anterior rotated pelvis about a right/left axis
  • increased pelvic tilt
  • increased lumbar lordosis (extension lesions)
  • Compensatory increase of thopracic kyphosis
    • can cause cervical extension for compensation
  • Round ligament pain(?)
  • posture based contraction of the psoas muscle
21
Q

How often do visits occur during third trimester?

A

Biweekly

22
Q

What can happen during third trimester if you treat a pregnant patient supine?

A

Could get Hypotensive

23
Q

Why should you avoid CV4 treatment during third trimester?

A
  • it can provoke uterine contractions
24
Q

What viscerosomatics should be treated or evaluated for complaints of Heart burn/GERD, Adrenal, Ovaries?

A
  • Heartburn/GERD→ Upper GI → T5-9
  • Adrenal → T10-L2
  • Ovaries → T10-L2
25
Q

What would treating the pelvic diaphragm potentialy help?

A

constipation

26
Q

During the last 4 weeks of pregnancy, how often are visits?

A

weekly

27
Q

During labor what OMT can be done?

A
  • evaluate lumbosacral region and pelvis use soft tissue MFR
  • expect dysfxn in innominates sacrum and pubic symphysis
28
Q

What causes rupture of the pubic symphysis?

A
  • fetal macrosomia
  • precipitous labor/rapid 2nd stage
  • intense contractions
  • previous pelvic trauma
  • forceps
29
Q

Signs and Symptoms of ruptured pubic symphysis?

A
  • hear audible crack, palpable gap larger than 1 cm with local tissue edema
  • acute pain radiating to back/thighs
  • waddling gait
  • inc pain on gait or bending
30
Q

Tx for rupture of pubic symphysis?

A

Bed rest, pelvic binder, OMM

31
Q

When should the first OMM visit occur post partum

A
  • first day post partum
  • treat before resolution of relaxin hormone
  • anterior sacral base due to the lithotomy position and pushinga baby (causes cranial extension)
    • treat this
32
Q

When should second visit post partum occur?

A
  • 4 weeks
33
Q

benefits of exercise in pregnancy? What are ACOG recommendations on how much exercise?

A
  • 30 min or more most days of the week
  • improves fitness and cardiorespiratory fxn
  • enhances psychological well being
  • dec risk for comorbidities due to sedentary lifestyle
  • prevent or resuce severeity of MSK complains
  • Reduce urinary incontinence
34
Q

What exercises should be avoided in pregnancy?

A
  • risk of falling
  • contact sports
  • jumping quick direction changes
  • heat
  • valsalva maneuver (can dec uteroplacental blood flow)
  • scuba diving
  • activity with high altidue
35
Q

Relative contraindication to aerobic exercise?

A
  • IUGR
  • Unevaluated maternal cardiac arrhythmia
36
Q

Absolute contraindications to aerobic exercise?

A
  • incompetent cervix
  • multiple gestations (triplets +)
  • IUGR
  • Persistent second or third trimester bleeding
  • Placenta previa >28 wks
  • Premature labor during current pregancny
  • PROM
  • Preeclampsia

ECOS IV Final (8 decks)

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